Provider Demographics
NPI:1598152134
Name:DONG, WILLIAM (LAC)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:DONG
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1808 SE 169TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97233-4468
Mailing Address - Country:US
Mailing Address - Phone:503-880-6712
Mailing Address - Fax:
Practice Address - Street 1:1808 SE 169TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97233-4468
Practice Address - Country:US
Practice Address - Phone:503-880-6712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-21
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC172209171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist